Fundamentals of Massage and Therapeutic

Exercise

Course Code -SpSc3102

Jimma University, 2020

Course Objectives

At the end of this course the student will be able to:

• Understand the Historical background of massage

• Familiarize with basic concepts of Fundamental Massage and

Therapeutic exercise

• Acquire the basic knowledge of Fundamental Massage and

Therapeutic Exercise

• Develop the skill of Massage and Therapeutic Exercise in

practice.

Unit 1: Introduction

• At some point in our lives every one suffers from minor

injuries, pain, or discomfort.

• Our instinctive reaction is to rub or hold the affected area to

ease pain.

• Early man probably soon learnt that, whilst rubbing painful

areas of his body, certain plants could applied which would

help to ease the pain and promote healing.

• This basic technique has been developed through the millennia

into the system of massage we know today.

What is Massage?

• Massage is the systematic (scientific art) and passive

manipulation of the body‟s soft tissues, primarily the muscles,

to benefit the nervous, muscular and circulatory systems

• Massage signifies a group of procedures, which are usually

done with hand on the external tissue of the body in a variety

of ways either with a curative, palliative or hygienic point of

view.

What is Therapeutic exercises?

• Therapeutic exercises refers to a wide range of physical activities

that focuses on restoring and maintaining strength, endurance,

flexibility, stability and balance. The goal of therapeutic exercises is

to return an injured patient to a fully functioning, pain-free state.

What is the purpose of Therapeutic exercises?

• Therapeutic exercise is the systematic performance or

execution of planned physical movements or activities intended to

enable the patient or client to remediate or prevent impairments of

body functions and structures, enhance activities and participation,

reduce risk, optimize overall health, and enhance fitness and

Aims of Therapeutic Exercise

The ultimate goal of a therapeutic exercise program is the

achievement of an optimal level of symptoms free movement during

basic to complex physical activities.

• To improve and restore physical function.

• To prevent loss of function.

• To enhance a patient‟s functional capabilities.

• To prevent and decrease impairment and disability

• To improve overall health status, fitness and sense of well-being

Types of Therapeutic Exercises

• Therapeutic exercises are classified according to the aim and

purpose of the exercises into many types:

1. Range of motion exercises which aim to maintain and increase

range of motion as traditional ROM exercises (passive, active and

active assisted ROM exercises) and techniques of joint

mobilization and soft tissue stretching.

2. Muscle performance exercises to increase muscle strength,

power and endurance as resisted exercises and endurance

exercises.

3. Postural exercises to improve posture and correct

faulty posture.

4. Balance and coordination exercises to improve

balance and coordination.

5. Relaxation exercises to induce relaxation.

6. Area specific exercises as breathing exercises and

circulatory exercises.

1.1. Historical Development of Massage

• The word massage is derived from Greek Word “Massein” that

means kneading.

• Other says it is related to the Latin Word “Manus” meaning hand.

Massage is one of the oldest techniques used for heating parts of the

body.

• Hippocrates, the father of medicine used to manipulate his patients

for treatment.

• Massage used primarily to promote the return of flow of venous

blood and lymph to the heart, thus relieving local swelling.

• Deep massage can break up adhesions, restoring a more complete

range of motion.

• Massage may be the oldest method of treating human ills.

• Massage probably originated from our natural impulse to rub an

ache or a bump to relive pain, over time this rubbing.

• Most forms of massage involve combinations of these

movements; with include stroking, kneading, wringing, pulling,

vibrating, percussing (tapping or striking) and pressing.

• There are different evidences that indicate in ancient China,

Egypt, Greece Rome and also the South African ancient ethnic

groups were practiced massage as therapeutic process.

1.2. Schools of massage

• Massage has become an umbrella term for many methods of

body manipulation most of these can be grouped into two basic

schools.

• The western school (Swedish Russian) the so-called structure

based system, arises from a European trade in that focuses on

the body musculoskeletal system.

• the most widely used western method is Swedish massage,

originally design to duplicate the muscle movements of Swedish

gymnastics through body manipulation.

• The eastern school of massage are energy-based systems

derived from the theory that a vital force circulates throughout

the body when this force is blocked by tension or injury, illness or

pain results.

• The aim of eastern techniques is to unblock areas where this force

has become trapped, thus restoring the flow of energy.

• The best known Eastern school is shiatsu, which uses pressure on

various vital points called Stubs to free blocked energy.

• Acupressure and reflexology, which also involve applying

pressure at vital points.

UNIT 2

Physiological Effects and benefits of Massage

2.1. The effect of massage on the body.

• Effect on the circulatory system: massage aids in the

mechanical emptying of the veins and the lymphatic.

• It facilitates the forward movement of the venous blood and the

lymph.

• reduces the chances of stagnation of the blood and the lymph in

the tissue space.

• On the arterial flow massage improves the blood supply of the

area being massaged.

• Effects on blood: massage is found to increase RBC and

haemoglobin count and may increase the oxygen carrying

capacity of blood.

• Effects on the exchange of metabolites: massage speeds up

the lymphatic and venous flow, which promotes rapid disposal

of the waste products of metabolism.

• These changes make the exchange of waste products between

the blood and the tissue at cellular level more efficiently.

• Effects on the nervous system: the nervous system consists of

sensory, motor and autonomic component.

• Different technique of massage produces effects on all these

components.

• Effects on the soft tissue: Massage has significant effect on

certain properties of the soft tissues like elasticity, plasticity and

mobility.

• The adhesions present between fibers are broken and maximum

mobility between fibers and adjacent structures is ensured.

• Effects on the respiratory system: percussion and vibration

techniques of massage assist the removal of secretions from the

larger airways.

• Effects on the skin: massage in general improves the nutritive

status of skin, rises the skin temperature.

• Massage facilitates the movement of skin over the

subcutaneous structures.

• As a result skin becomes soften, more agile and better.

2.2. Benefits of massage

• Enhance immunity by stimulating lymph flow the body‟s natural

defense system.

• Lessen depression and anxiety

• Increase joint flexibility

• Pumps oxygen and nutrients in to tissues and vital organs improving

circulation.

• Ease medication dependence

• Relive migraine pain

• Enhance the health and nourishment of skin

• Alleviate low back pain and improve range of motion

• Exercise and stretch wet, tight or atrophied muscles.

• Helps sportsmen of any level prepare for, and recover from, strenuous

workouts.

• Improve the condition of the body‟s largest organ the skin

• Enhanced sleep quality

• Improved concentration

• Promote tissue regeneration, reducing scar tissue and stretch marks

• Reduce post-surgery adhesions and swelling

• Reduce spasms and cramping

• Relax and soften injured, tired and overused muscles.

• Release endorphins-amino acids that work as the body‟s natural painkiller

Physical benefits of massage • Pumping – The stroking movements in massage suck fluid

through blood vessels and lymph vessels. By increasing the pressure in front of the stroke, a vacuum is created behind.

• Increased tissue permeability – Deep massage causes the pores in tissue membranes to open, enabling fluids and nutrients to pass through.

• Stretching – Massage can stretch tissues that could not be stretched in the usual methods. Bundles of muscle fibres are stretched lengthwise as well as sideways.

• Break down scar tissue – Scar tissue is the result of previous injuries or trauma and can affect muscle, tendons, and ligaments.

Benefits of massage…cont

• Improve tissue elasticity – Hard training can make tissues hard

and inelastic. This is one reason why hard training may not result

in improvements.

• Opens micro-circulation – Massage does increase blood flow to

tissues, but so does exercise. What massage also does is open or

dilate the blood vessels and by stretching them this enables

nutrients to pass through more easily.

2.3. Contraindication of massage

• Contraindication – means you are not able to receive

massage or the massage may be limited to certain areas

of your body. Contraindications are there for your

health and safety along with that of your therapist.

• Total Contraindication – A situation where massage is

avoided completely. There two common

contraindications during massage

1. General contraindications of massage

• In an undiagnosed injury

• High fever /high range of body temperature

• Renal diseases /kidney problem

• Cardiac diseases /heart problem

• Deep x-ray therapy Osteoporosis

• Sever debilitating illnesses such as cancer,

tuberculosis

2. Local contraindications of massage

• Acute inflammation / is a short-term process occurring in

response to tissue injury, usually appearing within minutes or

hours. It is characterized by five cardinal signs: pain, redness,

immobility (loss of function), swelling and heat.

• Skin diseases /

• Unhealed Recent fractures

• Varicose veins

• Atherosclerosis / a narrowing of the arteries caused by a buildup

of plaque. Arteries are the blood vessels that carry oxygen and

nutrients from your heart to the rest of your body.

• Thrombosis / The formation or presence of a blood clot in a blood

vessel. The vessel may be any vein or artery as, for example, in a

deep vein thrombosis or a coronary (artery) thrombosis.

UNIT 3: PREPARATION FOR MASSAGE

3.1. Massage room

• The room should be warm, cool or chilly air may not only feel

unpleasant.

• An optimal at room temperature is 22-25oc.

• The windows should be closed during massage.

• Lighting should be soft; avoid overhead or fluorescent lights.

• Slow music or classical music will contribute to the soothing,

relaxing mood of the massage.

• Ventilating the room advisable before start massage.

4 Ways to Be Prepared for Your Massage • Muscle tension and life„s stressors may be the reason for your

visit, there„s no need to stress about your massage too.

• If you know how to prepare for a massage appropriately, you

can walk into your appointment ready to take in the full benefit

of your session.

1. Hydrate Before and After an Appointment

Make sure you are hydrated before you go to your massage

appointment and prepared to drink plenty of water following your

appointment.

Ultimately, stressed muscles lead to inflammation and toxin build

up that can block essential nutrients and oxygen from getting to

where they need to go and thus contributing to pain and stress.

2. Wear Loose Comfortable Clothing

• When you prepare for a massage, plan to wear or at least bring

loose comfortable clothing with you. Plan to wear loose

comfortable clothing to your massage to begin your relaxation

process.

3. Breath Normally

• The relaxation of your body and mind is key to getting the most

out of your massage session. Your therapist will be working to

loosen your muscles. Normal breathing helps expedite relaxation.

4. Don’t Be Afraid to Communicate

• Your massage therapist is there to help you feel better. If you have

a specific problem area or purely just want to relax on the table –

let your therapist know.

What you expect from your massage?

1. You Will Be Asked to Undress

• Your massage therapist will leave the room to give you the privacy

you need to remove your clothing; it„s up to you if you choose to

undress completely or to leave your underwear on before you slip

under the top sheet of the massage table.

2. You Might Fall Asleep

• One of the biggest compliments for a massage therapist is the

sound of snoring during a massage session. A massage session can

offer you such relief and relaxation that you might find yourself

nodding-off for a bit. Don„t worry! Snooze away.

3. You’ll want to Come Back

• The release of the feel good„ endorphins will have you feeling a

natural high. Those endorphins leave you feeling relaxed and

energized at the same time. It„s a wonderful feeling!

3.2. Tools and Equipment of massage

• Massage table: massage can be conducted on a massage table or on the floor.

• Massage tables are available in wood or metal and measure about 60-80 Cm height, 65-68cm width and 200-210 Cm length.

• Bolsters: use ready-made bolsters and/or pillows and/or rolled up towels. Have a mixture of sizes to accommodate your clients„ requirements.

• Purchasing linen: top of the range quality is not essential. Linen needs to be of varying sizes, not translucent or see-through, and of the colour that best suits the clinic and company branding.

• Washing linen with oil: be careful! Oil is a combustible substance.

1. Linen and massage table accessories

• A set of linen consists of:

• Dressing the table

1. A fitted table cover

2. A fitted sheet or bath sheet (spa size towel) to cover the table

cover

3. A fitted cover, hand towel or disposable cover for the face cradle

(be careful of allergy to latex)

4. Pillow cases to cover any pillows

5. Hand towel to cover bolsters for the client

6. A bath sheet (spa size towel)

7. A bath towel

8. A hand towel

• Bolsters: use ready-made bolsters and/or pillows and/or rolled up

towels. Have a mixture of sizes to accommodate your clients„

requirements.

• Purchasing linen: top of the range quality is not essential. Linen

needs to be of varying sizes, not translucent or see-through, and

of the colour that best suits the clinic and company branding.

• Washing linen with oil: be careful! Oil is a combustible

substance. Use a clothes dryer on a low heat for a short period of

time – and check on it. The best and safest method of drying

linen is on a clothes line to dry naturally.

2. Create the clinic environment

• Safety and security: a clinic should be, and feel, safe, secure,

private and dry.

• Room Temperature: a clinic room should be warm –

appropriate to the seasons. Keep the room smelling fresh.

Remember some people are allergic to sprays and flowers.

Bathroom facilities: should be close by for the clients to use

and for hand washing immediately before and after each

massage.

• Music ... Or not? Ask your client. If ―yes, provide some

options.

3 .The client/athlete

1. Treat every client with respect, with dignity, and with

inclusiveness – they have a right to be included in their treatment

plan discussion.

2. Gain their written consent to that plan before the massage session

begins.

3. If the plan is modified during the massage, verbal consent is

necessary and should be included in the clinical notes for the

session.

4. Apply the Code of Ethics and Standards of Practice – ALWAYS.

5. Drape men and women exactly the same way – breasts and

genitalia should be covered at all times.

6. Only ever uncover the area you are working on unless modality

specific in context with the treatment, the pathology and within

your scope of practice.

4. Communication

1. Engage in active listening – listen, hear, paraphrase.

2. Use professional language – and use lay terms as they are not

health professionals.

3. Ask open-ended questions.

4. Include your clients in their treatment plan.

5. Take extensive clinical notes.

6. Set up a pressure feedback system -check in with your clients

during the massage to ensure applied pressure is adequate and

comfortable.

Massage powder, oils, and creams:

• Talcum powder, allows a free gliding movement.

• Use in excess is harmful to the function of the skin, it can

close skin follicles and impede sebaceous secretion causing

local inflammatory reaction.

• Olive-oils, sunflower, paraffin, wintergreen, the sensitivity

of the therapist finger is good when oil is used to sense

resistant areas.

• But whatever medium is used it should be as minimum as

possible to insure gliding movements of the fingers.

3.3. Positioning and draping the client during

treatment • The issues surrounding the practice of draping and positioning

are numerous. They include legal, moral, therapist training and practice and protection of the consumer.

• The Draping and Positioning Policy is designed to facilitate best practice for client draping during treatment and to provide optimal client comfort and safety.

•

• Massage Therapists must recognise, accept and respect the right of every individual client to choose whether he or she wishes to decline treatment based on the draping and positioning methods used.

Principles of Draping

1. Introduction and explanation to the client athlete

2. Create an environment of safety and security

3. Ensure comfort and temperature control

4. Setting and maintaining boundaries

5. Draping materials, transport, storage and laundry / if

necessary/

6. Therapist Occupational Health and Safety.

Draping Guidelines

Position statement • During massage positioning depends up on the aim of treatment,

the parts to be assessed or treated.

• Prone position- Recommended position for treating

–Posterior neck muscles

–Upper and lower basic muscles

–Gluteal region

–Back of thigh and leg

Supine position- Recommended for all muscles of

• head and neck

• pictorials

• abdominal

• quadriceps and

• anterior compartment of leg

Seated upright- upper trapezius

• Seated inclined- Muscles of the posterior aspect of the head

and neck

• Muscles of the upper back

• Muscles of the posterior aspect of the upper arm

• Draping: - should place the client in safe warm and

comfortable position to receive the desired massage.

Undraping Rules

• One part should be undraped at a time

• Undrape only those areas which have to be treated.

• Gluteal cleft, perineum, genital and female breast should not be

undraped.

• Infant under the age of two years may be treated undraped.

• Necessary equipment„s includes sheets, towels, pillows and

blankets should be available for draping the massage partner.

• Massage powder, oils, and creams:

• Talcum powder, allows a free gliding movement.

• Use in excess is harmful to the function of the skin,

• it can close skin follicles and impede sebaceous secretion

causing local inflammatory reaction.

• Olive-oils, sunflower, paraffin, wintergreen, the sensitivity

of the therapist finger is good when oil is used to sense

resistant areas.

• But whatever medium is used it should be as minimum as

possible to insure gliding movements of the fingers.

Draping: - should place the client in safe warm and comfortable

position to receive the desired massage.

Undraping Rules

• One part should be undraped at a time

• Undrape only those areas which have to be treated.

• Gluteal cleft, perineum, genital and female breast should not

be undraped.

• Infant under the age of two years may be treated undraped.

• Necessary equipments includes, sheets, towels, pillows and

blankets should be available for draping the massage partner.

UNIT 4: BASIC TYPES AND TECHNIQUES OF

MASSAGE

4.1. Types of massage

• There are more than 250 variations of massage, body work and

somatic therapies and many practitioners utilize multiple

techniques.

• Massage can be divided by system, method, form, purpose, type,

application and technique (classification).

• By methods of application massage can be divided in to: -

–Hand massage

–Apparatus massage

–Combine (Hand and apparatus)

• By form massage can be classified:

–Full massage

–Regional massage

By purpose massage can be classified:

Health massage: - Incorporating the most familiar Swedish and

Russian based techniques, full body massage relaxes the entire body.

• It benefits the nervous, circulatory and musculoskeletal systems,

and promotes a general sense of psychological well-being.

• It may be conducted with lubricants or dry massage and

required from 45 minutes to an hour.

Therapeutic medical massage (TM):- It is a type of massage

relating to the treatment of disease and curative process.

• It served or performed to maintain health.

Sport massage: - Sport massage works specific muscle groups

used in exercise to increase muscle tone flexibility and reduce the

likelihood of injury.

• Sport massage is designed to enhance athletic performance and

recovery.

Cosmetic massage: - it treats the face, head and neck to increase

circulation to the skin and

• enhance muscular flexibility; this improves skin tone and

appearance.

• The main purpose is to achieve deep relaxation. honey partial

body massage.

• This is a combination of beauty and therapeutic massage with

herbal honey.

Application massage for sport can also divided into

• Massage applied to injury

• Sport massage to prepare the players for the competition

• Massage after training: also classified as anti-fatigue sports

massage. No stimulatory

• Massage prior to the game: To stimulate the muscle and assist

to passive warm up

• Massage the day after the game: It will reduce soreness in

muscle and stiffness in joint addition to lactating minor injury

such as minor contusion, strain, sprain, etc

4.2. Basic Technique of Massage

On the basis of character of technique:

• Stroking manipulation or Effleurage: the uninterrupted linear

movement of hand along the whole length of body.

• i. Superficial stroking: the rhythmic movement of hand or parts

there over the skin with the lightest amount of pressure in order to

obtain sensory stimulation.

• ii. Deep stroking: the movement of the palmar aspect of hand over

the external surface of the body with constant moderate pressure, in

the direction of the venous and lymphatic drainage.

Pressure manipulation: the hand of the therapist and the skin of

the patient move together (kneading, Petrissage and Friction).

• Kneading: the tissues are pressed down on to the underlying

firm structure and intermittent pressure is applied in circular

direction, parallel to the long axis of bone.

• Palmar kneading: pressure is applied with the palm.

• Digital kneading: pressure is applied with the fingers (finger

kneading) or thumbs (thumb kneading).

• Reinforced: both the hands, placed over one another, are used

to apply pressure.

Cont.. • In general kneading has 7 classifications

1. Whole hand kneading

2. Palmar kneading

3. Finger kneading

a. flat finger kneading

b. finger pad kneading

c. finger tip kneading

4. Thumb kneading- a. thumb pad kneading

b. thumb tip kneading

5. Superimposed /reinforced kneading

6. Elbow kneading

7. Heel of hand kneading

• Kneading can help on many circumstances. Kneading is used to:

• Treat high Muscle Tone

• Treat tight muscles

• Produce relaxation

• Palmar kneading: pressure is applied with the palm.

• Digital kneading: pressure is applied with the fingers (finger

kneading) or thumbs (thumb kneading).

• Reinforced: both the hands, placed over one another, are used

to apply pressure.

• Kneading treats high muscle tone. Increased tone is tension in

the muscle when at rest.

What are the benefits of kneading?

Kneading has many benefits. The benefits of kneading include:

• Decreased tension

• Increased flexibility

• Decreased muscle pain

• Reduced stress

• Kneading treats areas of tension and can be beneficial in

reducing tightness. It relieves tension in the muscle by applying

alternate pressures to stretch and mobilise the muscle fibres.

• There are many common body parts that can be treated with

kneading. Common body parts treated by kneading are:

• Neck, Shoulder, Upper back, Lower back, Thigh, Calf

Petrissage: the tissues are grasped and lifted away from the

underlying structures and intermittent pressure is applied to

the tissues. Petrissage massage technique can include

stretching, kneading and squeezing soft tissues and

underlying muscles. Petrissage lifts tissues away from

structures to relieve tension and stretches and loosens

muscles fibres. Petrissage is also stimulates the skin

including vascular and lymphatic responses.

• What is petrissage used for? Petrissage is an effective massage

technique used to:

• Increase blood circulation

• Stretch and loosen muscle fibres

• Increase range of movement

• Petrissage is used to improve blood circulation, increase

recovery, stretch and loosen muscle fibres and increase range of

movement. Petrissage is used to increase blood circulation.

Increase blood circulation increases temperature of the muscles

allowing them to relax.

• What are the benefits of petrissage?

Petrissage has many benefits. The benefits of petrissage include:

• Decreased tension

• Reduced delayed muscle onset soreness

Improved recovery

• . Petrissage has many benefits. The benefits of petrissage are

decreased tension, reduced DOMS and improved recovery.

• A benefit of petrissage is decreased tension. Petrissage uses

various techniques and strokes to increase circulation and

promote relaxation.

• Petrissage allows muscle fibers to move move freely and tension

to be released.

Some examples of petrissage massge are:-

• Picking up: tissues are lifted away from underlying structures,

squeezed and then released using one or both the hands.

• Wringing: using both the hands, tissues are lifted away from the

underlying structures, squeezed, twisted and then released.

• Skin rolling: the skin and fascia are lifted up with both the hands

and moved over the subcutaneous tissues by keeping a roll of lifted

tissue continuously ahead of the moving thumb.

How does petrissage help?

• Petrissage helps by increasing blood circulation, increasing

tissue elasticity and removing waste products from the muscles.

• Petrissage helps by increase fresh blood to the muscles and soft

tissues. When petrissage massage is performed it stimulates the

skin surface and encourages a vascular and lymphatic response.

• The vascular response allows the blood cells to widen and

multiple to aid the body's healing process. Petrissage also helps

by increasing tissue elasticity.

• It is able to lift up tissues away from others relieving tension.

• Friction: in this technique the tissues are subjected to small range

of to and fro movement performed with constant deep pressure of

the finger or thumb.

• Friction is a massage technique used to increase circulation and

release areas that are tight; particularly around joints and where

there are adhesions within the muscles or tendons.

• It is defined as ―an accurately delivered penetrating pressure

applied through fingertips.

Purpose

• The goal of friction massage is to influence cell behavior in all soft tissues. Friction massage is supposed to induce:

• Traumatic hyperemia, which helps to evacuate pain triggering metabolites.

• Movement of the affected structure which prevents or destroys adhesions and helps optimize the quality of scar tissue and mechanoreceptor stimulation.

• Stimulation of mechanoreceptors, producing a quantity of afferent impulses that stimulate a temporary analgesia.

• Fibroblastic proliferation, responsible for the repair en regeneration of collagen.

• Realignment of collagen fibers, determined by the magnitude of applied pressure.

Circular friction: direction of movement is circular.

Transverse friction: to and fro move

When are frictions used?

• Frictions can be used to help in many circumstances. These

circumstances include:

• Post Injury

• Scarring

• Acute pain

-Friction massage can be used after injury. Massage can play an

important role as part of rehabilitation for injury.

-Frictions are a specific massage technique used to help relieve tight

tissues after injury.

-Frictions are an effective massage technique to help treat scar tissue.

Scar tissue is formed in the body as part of the healing process.

-Frictions can also be used to increase acute pain.

-When friction is performed over ligaments and around joints, the

circulation to the area is increased.

What are the physiological effects of frictions?

• Massage can produce many important physiological effects on

the body. The physiological effects of frictions include:

Increased vasodilation

Improved recovery

Breakdown / realignment of collagen fibres

Breakdown of scar tissue

Increased range of movement

Increased tissue elasticity

What are the benefits of frictions?

• Frictions have many benefits. The benefits of frictions include:

Increased range of movement

Improved healing

Decreased pain

• One benefit of the friction technique is increasing range of

movement. Frictions are used to treat tight and restricted

tissues.

• Frictions are a beneficial massage treatment to assist in

improving healing. Frictions improve healing by treating scar

tissue/adhesions.

• Frictions help to decrease pain. When tissues are tight and

restricted, pain increases due to the lack of movement available

around an area. Frictions performed onto an affected area can

treat the tissue and help relieve pain.

Common body parts treated by frictions

• There are many common body parts that can be

treated with friction massage.

• Common body parts treated by frictions are:

Jaw

Shoulder

Arm

Hand

Foot

-Frictions can also be performed on other areas of the

body and be effective to reduce scar tissue, and pain.

Percussion manipulations massage

it is a series of soft and gentle blows are applied over the body.

It Strikes the body part at regular interval. It has 6 classifications.

1. Clapping: Administered with Cupped palm. Cupping is

performed with cupped hands to create a slight vacuum. It is

applied in an alternating fashion as a succession of brisk claps on

the thoracic region of the back.

2. Hacking: Administered with Ulnar border of the 5th, 4th and

3rd digits. It consists of a succession of short, sharp strikes

performed with alternate hands. It is applied using the ulna borders

of fingers and hands with the fingers extended and together.

3. Tapping: Administered with Anterior aspect of the clenched fist.

Flicking is the lightest tapotement technique applied with loosely

held fingers in a gentle rhythmic alternating fashion. It can be

applied to areas such as the face, chest and arms.

4. Beating: Administered with pulp of the fingers

5. Pounding: Administered with Medial aspect of the clenched fist.

Pummelling is performed with loosely closed fists, working

alternately with the ulnar aspects of the hand striking the body.

It is applied over areas of large muscle mass.

6. Vibratory manipulations: the mechanical energy is transmitted

to the body by the vibrations of the distal part of upper and lower

limbs,

• This technique is mainly directed towards the lung and other

hollow cavities.

• Vibrations: which tend to produce fine movement of limbs in

upwards and downward direction.

• Shaking: which tend to produce fine movement of limbs in

sideway direction.

• It may in 2 ways 1. for long muscle 2. for small or short muscle

What are vibrations?

• Vibrations are a massage technique in which tissues are pressed

and released in an up and down movement.

• A vibration massage creates a vibrating and shaking motion onto

the muscles that can be performed in a soothing or stimulating

way.

• Vibration massage technique is a fine, gentle, trembling

movement performed with hands or fingers. Vibrations can be

used to stimulate soft tissues in the body.

• Vibration movements can help stimulate nerves, relieve muscular

tension and decrease stress.

• Vibrations at a slower pace are an effective treatment to produce

a feeling of relaxation.

When are vibrations used?

Vibrations are a massage technique which can be used:

• Pre Event

• For tight muscles

• Vibrations are an effective massage technique used pre event to

promote stimulation.

• The aim of pre event massage is to increase blood circulation,

flexibility and mentally prepare people for activity and enhance

performance.

• Specific massage techniques such as vibrations are used to create a

short but specific massage treatment.

What are the physiological effects of vibrations?

• Massage can produce many important physiological effects on the body. The physiological effects of vibrations include:

Increased Temperature

Increased cellular exchange

Increased venous return

• Vibrations increase the temperature of soft tissues. Vibrations

stimulate an increase of temperature by friction against the skin.

• Vibrations can also increase cellular exchange in the tissues.

Cellular exchange is the transportation of oxygen and nutrients.

The increase of cellular activity within the tissues can also begin

to remove waste products out.

What are the benefits of vibrations

• There are many benefits of vibrations. The benefits of vibrations are:

Relieved tight muscles

Reduced stress

Improved blood circulation

• Vibrations are a beneficial massage technique to help relieve tight muscles. Vibrations can reduce tightness by increasing blood circulation and temperature of the muscles.

• Vibrations can be used to reduce stress. Stress can be related to emotional or physical events in life, such as work life, health or sporting performances.

• Vibration technique is an effective massage technique to improve circulation in the muscles.

• Vibrations are part of the percussion techniques which are performed quickly onto larger muscle areas.

Common body parts treated by vibrations

• There are many common body parts that can be treated with

vibrations. Common body parts treated by vibrations are:

• Shoulder, arm, upper back, lower back, buttock, thigh and calf.

• Vibrations can also be performed on other areas of the body and

be effective to stimulate muscles and relieve tightness.

Other classification of massage

• On the basis of depth of tissue:

Light massage: The force applied during the maneuver is light,

• so that the effect of massage is confined to the superficial tissue

only, e.g. stroking, tapping, etc.

Deep massage: The forces applied during the massage are

moderate to deep

• so that the effect of massage reaches to the deeper tissues like

muscle, e.g. friction, kneading, etc.

• On the basis of part of body massaged:

• General massage: Massage applied to the entire body is usually

termed as general massage.

• Local massage: When massage is administered in a particular

area of the body segment.

• On the Basis of Means of Administration of Technique:

• Manual Massage: The massage administered with the hand or

other body part of the therapist is called manual massage.

• Mechanical Massage: When the mechanical devices based on

the principles of massage, administer the mechanical energy to

the patient‟s body, in order to manipulate soft tissue.

Unit 5: Classification of massage and their application

“This chapter will be practical”

Read the given manual and ready for the lab practice on massage techniques and their applications

CHAPTER 6- SPORT MASSAGE

6.1 Definition

What is a Sports Massage?

• A sports massage is typically a combination of several massage techniques that are tailored to your affected muscle groups based on the activities that you do.

• A properly administered sports massage can help flush the lactic acid out of your body.

• There are two types of sports massages that can benefit triathletes depending on when you schedule your appointment and your race schedule.

• If you have a race coming up you will want to receive a lighter massage. But, if you are in between events and have specific issues, your sessions can focus on deep-tissue massages in problem areas.

Why sport massage? What exactly is a sports massage and what will it do for a triathlete?

Athletic Performance

• Continual improvement is the reason you train in the dead

of winter, hammer up the hills on the bike, do track work,

and train in the pouring rain. Well, that is the same reason

you should get a good sports massage.

• After a massage you'll feel lighter, more powerful and

more flexible, and all those nagging aches and pains can

be addressed, helping to reduce the likelihood of injury.

Injury Prevention

• One of the best reasons to get a sports massage is to help your muscles, tendons and joints move through their proper range of motion and stay in optimum shape. It's just like that pre-workout warm-up you're supposed to do.

• Many injuries are brought about by overusing certain muscles. This can result in soreness, pain and inflammation.

• Regularly scheduled sports massages can help reduce the likelihood of the muscles becoming overused in the first place and can also help reduce the initial inflammation that leads to injury.

• It can also help reduce the chance of injury recurrence. Massage is most effective at treating soft-tissues injuries such as strains, sprains and stress injuries.

Pain Reduction

• Massage has been known to reduce pain from

recovering injuries or tight muscle areas. Massage

promotes proper healing of scar tissues and can provide

a soothing effect on injured areas.

Relaxation and Focus

• Sports Massage can help decrease stress and increase

focus, putting you in a good psychological state before

your next race. The brisk movements of the massage

can also leave you feeling invigorated

Post-Race Recovery

• Massage can help hasten the healing and recovery

process after an intense race by dissolving waste fluids

such as lactic acid.

How often should you get a sports massage?

• On average, a triathlete should get one massage per week

or a minimum of one per month. That may seem

extreme, particularly if a trip to the spa is more of an

indulgence for you. But, massages go a long way to help

prevent injury.

When should I get a sports massage?

• People respond in different ways to a massage so if you

have the luxury to try one at different times in your

training then determine what is right for you.

• However, the majority of people will tend to favor the

post-race/post-long workout time more. Both are

beneficial but the pre-race massage will stimulate your

muscles whereas the post-race massage is more of a

cool-down/recovery massage.

Four reasons why sports massage can benefit every body-

1. Release muscle tension

• During periods of stress on the body your muscles can create trigger points and tension. Having regular massages can optimize your tissue pliability, which in turn can reduce injuries and improve mobility.

2. Support good posture

• We can all spend long times at our desks however this posture can cause muscles to shorten and pull your joints into positions which over time can reduce function and increase chances of over-use and repetitive strain injuries.

• Sports massage can help to release these muscles and is a great way to counteract the negative affect working at a desk has your posture.

3. Reduce pain

• Massage and soft tissue can be used alongside

physiotherapy intervention to help reduce pain

produced by injury. There has been a variety of

research demonstrating the positive impact of

massage on pain levels in lower back and shoulder

pain when combined with exercises and manual

therapy techniques.

4. Assist with recovery

• If you have trained a muscle group to help reduce

Delayed Onset Muscle Soreness (DOMS), massage

may help recovery by increasing circulation to the area

massaged and helping to flush out the toxins that build

up during exercises. This can help improve your

recovery and leave you better able to optimize your

training in the following days.

6.2. Effect of massage on sport/ exercise activities

• The physical effect of massage on muscle recovery and repeated

sports performance is controversial.

• Massage appears to have a positive effect on athletes' perceptions

about muscle recovery.

• Massage is most likely to reduce delayed muscle soreness when

administered two to six hours after intense exercise.

• Massage may effect on sport in 3 ways. Physical effect,

psychological effect and physiological effect.

1. Physical effects

• A physical effect can be defined as a mechanical change that happens to a structure being massaged.

• Physical effects are likely to occur to more external structures of the body where massage is directly applied.

Examples of physical effects include:

Improved flow of fluids (e.g. blood and lymph) due to the

mechanical pumping and squeezing action of massage techniques.

Stretching of soft tissues in a longitudinal or transverse direction

which can assist in tissue mobility and the linear formation of

tissue during healing.

Separation of muscles or connective tissue fibres that have

become stuck to one another (reduced adhesions).

2. Psychological effects

• A psychological effect is a change of state of mind, perception

or mood. These effects may be less tangible than other effects,

but no less important.

• The psychological effects of sports massage can depend on the

initial mood or mental state of the client, their expectations, the

type of massage given and the physiological and neurological

effects.

• For example, an invigorating massage can increase mental

alertness and prepare a client for upcoming activity.

3. Physiological and neurological effects

• A physiological effect is a change that occurs to internal body

processes as a result of the massage.

• Neurological effects are changes which occur in the nervous

system and as such are very closely linked with any physiological

effects.

• Physiological or neurological effects depend on the type of

massage experienced.

• A slow relaxing massage would initiate a parasympathetic

response, whereas a quick, invigorating massage may initiate a

sympathetic response.

• In most instances, a parasympathetic response would be

beneficial, but during a pre-event massage, the therapist would

be looking to elicit a sympathetic response to prepare the client

for the upcoming activity.

• Examples of parasympathetic effects include:

– Vasodilation of blood and lymphatic vessels as smooth muscle

relaxes.

– Reduced neural stimulation (contraction) of muscles as skeletal

muscles relaxes.

– Reduced production of sympathetic (stress„) hormones.

– Reduced heart rate and blood pressure.

4. Effects of sports massage on the skin

• As soft tissues are physically mobilised, skin elasticity will

improve and exfoliation of superficial cells will occur.

• Vasodilation of surface capillaries will provide an increased

supply of nutrients and oxygen to the reproductive layers of the

skin.

• This will present as erythema (reddening of the skin). Sebaceous

glands are also stimulated, increasing oil production and

lessening the risk of dry cracked skin.

5. Effects of massage on the lymphatic systems

• Superficial and deep massage strokes which physically

manipulate the skin, fascia and muscle will help to improve

lymphatic circulation and drainage.

• This will increase the removal of metabolic waste from tissues.

• The increased speed of lymph flow through the vessels and the

lymph nodes will stimulate lymphocyte production, therefore

improving the ability of the body to prevent and fight infection.

6. Effects of massage on the neuroendocrine system

• Sympathetic or parasympathetic responses will be stimulated by a

particular type of massage (relaxing or invigorating).

• The nervous system will then pass on the appropriate stimulations

to other systems to elicit either a parasympathetic or sympathetic

response, including the endocrine glands which will produce

hormones to rebalance the autonomic nervous system.

• The reduction of tension in soft tissues and removal of metabolic

wastes will reduce the potential causes of irritation to nerve

endings.

• This may lead to reduced perception of pain or discomfort,

particularly in tight or recovering tissues.

• During exercise, glucose and oxygen are delivered to the

muscles and converted in to glycogen, a source of energy for

them.

• When exercise is long or strenuous, this process becomes less

efficient and allows the build-up of lactic acid, a by-product of

energy production that tires the muscles and may cause

soreness.

• By “ milking “ the muscles, massage speeds the removal of

lactic acid, which is carried through the bloodstreams to the

liver and resynthesized in to glycogen in the liver and muscles.

6.3. Massage before, during and after sport competition

• Sport massage is a four-part regimen designed to aid the

athlete in training, both before and after a competition or

workout, and in rehabilitation from injury.

• Pre event sport massage, which demonstrated is in training to

help keep the exerciser injury-free, and so allow him or her to

work to maximum capacity.

• The pre-event massage stimulates circulation promotes muscle

flexibility; both help prepare the muscles for the upcoming

activity and reduce the risk of injury.

• Pre-event massage is delivered at the performance site, usually

with the athlete fully clothed.

• It may fact-phased and stimulating, it helps to establish blood

flow and to warm up muscles.

• During the massage, the athlete generally focuses on visualizing

the upcoming event.

• After exercise, the task of massage is not to stimulate and

prepare muscles, but to relax them and aid in their recovery.

• Post-event massage can reduce recovery time, enabling an

athlete to resume training much sooner than rest alone would

allow.

Key Principles of Sports Massage

• Three specific principles are vital to understanding what

type of sports massage to apply to an athlete at any given

time. We call these principles the "when, what and why" of

sports massage: Timing, Technique and Intent.

1. Timing- refers to when the massage is given: pre-event or

post-event; during recovery; during a maintenance period;

2. Technique - refers to what application you utilize, and

can include a number of different techniques: (effleurage;

friction; pettrisage; vibration; shaking; compression;)

3. Intent- refers to your reason(s) for treatment: (as

warm-up; to increase blood flow; stimulate neurological

pathways; aid recovery from exertion; increase flexibility;

improve strength; or improve posture).

Activity

1. Write the effects of sport massage in pre-event, during

event and after event.

2. Discuss on the difference between sport massage and

massage.

UNIT -7 EXERCISE THERAPY

7.1. Introduction

• Rehabilitation services are often necessary after injury or

illness to build strength and improve function. Rehab

therapists use many different interventions to address

functional limitations.

• Therapeutic exercise and therapeutic activities are two

common interventions that are used to address dysfunction

caused by disease and injury. Although both interventions aim

to improve function, they are distinctly different.

• The Difference between Therapeutic Exercise & Therapeutic Activities

• Therapeutic exercise -- involves instructing a patient in specific exercises to address weakness or loss of joint mobility due to disease or injury.

• These exercises are not typically functional tasks. For example, overhead shoulder presses using dumbbells is a therapeutic exercise.

• Therapeutic Activities

• Therapeutic activities -- involves the use of functional, dynamic tasks from everyday living to improve range of motion and strength. For example, overhead shoulder movement can be strengthened by reaching up to place a weighted object on a shelf.. Therapeutic activities cover a broad range of functional tasks. Movements including pushing, pulling, squatting, bending, lifting, carrying, catching and throwing qualify as therapeutic activities.

Activity

• What the similarities of therapeutic activity and therapeutic exercise? List down and on them.

7.2. Types of muscular contraction

• What are the 3 types of muscles contractions?

• So, the term tension, rather than contraction, is better suited to

define the actions (dare I say, contractions!) of a muscle.

• Therefore, muscles, under tension, may:

1. Shorten,

2. Lengthen, or

3. Remain the same length.

• It is these three different types of muscular tensions that are used

to define the three different types of muscular contractions.

The three different types of muscular contractions, therefore, are:

1. Concentric contractions (shorten)

2. Eccentric contractions (lengthen)

3. Isometric contractions (remain the same)

1. Concentric Contractions

• Concentric contractions are those which cause the muscle to

shorten as it contracts.

• An example is bending the elbow from straight to fully flexed,

causing a concentric contraction of the Biceps Brachii.

Concentric contractions are the most common type of and

occur frequently in daily and sporting activities.

• A concentric contraction is a type of muscle contraction in

which the muscles shorten while generating force.

2. Eccentric Contractions

• Eccentric contractions are the opposite of concentric and occur

when the muscle lengthens as it contracts.

• This occurs when lowering the dumbbell down in a bicep curl

exercise.

• The muscle is still contracting to hold the weight all the way

down but the bicep muscle is lengthening.

3. Isometric Contractions

• In contrast to isotonic contractions, isometric contractions

generate force without changing the length of the muscle.

• This is typical of muscles found in the hands and forearm: the

muscles do not change length, and joints are not moved, so

force for grip is sufficient.

• An example is when the muscles of the hand and forearm grip

an object

7.3. Active and passive movements

• Definition-

• Active exercises require exertion to move the muscles. This

includes stretching to improve range of motion, resistance

training to build muscle mass and aerobic exercises in which

the muscles move the body to increase the heart rate.

• Active exercises are also useful in rehabilitation to develop

nerve pathways and make it easier to control action.

• Active exercises provide more benefits than passive

exercises and are preferred in the rehabilitation process

when not contraindicated by health conditions or ability.

• Passive motion- A therapeutic exercise technique used to move a

patient's joint through a range of motion without the patient's use

of the involved extremity. The motion is accomplished by a

therapist, an assistant, the use of a machine, or by the patient's use

of the non-involved extremity.

• Active range of motion exercises help to increase and reach your

full range of motion for a joint by actively using the muscles to

move your joint through its full range of motion.

Classification of free exercise or active movement –according to extent

to era it classified into two.

• 1. Localized – produced some specific or local effect. Eg. For

particular joint or muscle, flexion of elbow joint.

• 2. General active movement- use of many joints. Eg. Walking,

running.

Other types of active movements are:-

A. Active Assisted Exercise - Voluntary contraction of a muscle, which

is able to produce little movement but is not sufficient enough to

produce the movement in full range of motion.

Indications of active assisted exercise are:

–Strengthening of the weak muscle

–Coordination of movement

• No pain, no gain? Not necessarily. If you're recovering from

injury or surgery, active assistive exercises can help you

increase your strength without increasing your pain. Active

assistive exercises are a traditional part of rehabilitation

programs. Active assistive means that you perform as much of

the task as you can, with help to complete the movements.

B. Active Resisted Movement - A movement or exercise is

carried out against the resistance in available range of motion.

• • The intra-muscular tension is increased as the resistance is

appalled against isometric or isotonic of contraction of muscle.

Resistance can be applied by: Therapist, Patient, Weight,

Spring, Therabands, Weighted Medical ball and Water or

others.

The passive movement has three types

1. Relaxed passive movement - These are movements performed accurately, rhythmically and smoothly by the physiotherapist through available range of motion (according to anatomy of joints)

2. Forced passive movement -An exercise performed on a subject by a partner who exerts an external force not only to produce a passive movements of a joint.

• The partner presses the joint into its end-position (i.e. end of range), while the subject„s muscles that normally carry out the movements are completely relaxed.

•There is a danger of overextension beyond the range of movement and damage to the joint if the exercise is not carried out carefully.

5. Continues passive motion - devices are used during the first

phase of rehabilitation following a soft tissue surgical procedure

or trauma.

The goals of phase 1 rehabilitation are: control post-operative

pain, reduce inflammation, provide passive motion in a specific

plane of movement, and protect the healing repair or tissue.

Activity

Discuss on the characteristics of muscle contractions with

their examples

1. Concentric contractions

2. Eccentric contractions

3. Isometric contractions

UNIT -8 THERAPEUTIC APPROACH

8.1. Mobilization of peripheral joint • Joint restriction can be a daunting task to improve in patient/

injured athlete care.

• Understanding when to mobilize the joint or provide soft tissue

mobilization is imperative to successful patient/athlete outcomes.

• This one-day Peripheral Joint Mobilization course focuses on

mobilization techniques for the shoulder, hip, knee, ankle, elbow

and wrist joints.

• This one-day Peripheral Joint Mobilization course focuses on

mobilization techniques for the shoulder, hip, knee, ankle, elbow

and wrist joints.

8.2. Breathing exercise • Breathing exercises are exercises that enhance the respiratory

system by improving ventilation, strengthening respiratory

muscles, and increasing endurance.

Why Breathing Exercises Help

• When you have healthy lungs, breathing is natural and easy.

• You breathe in and out with your diaphragm doing about 80 % of

the work to fill your lungs with a mixture of oxygen and other

gases, and then to send the waste gas out.

• Lung Helpline respiratory therapist Mark Courtney compares the

process to a screen door with a spring, opening and shutting on its

own. "Our lungs are springy, like the door.

8.3. Relaxation

• It is the act of relaxing or state of being relaxed.

• Relaxation is the emotional state of a living being, of low

tension, in which there is an absence of arousal that could come

from sources such as anger, anxiety, or fear.

• It is when the body and mind are free from tension and anxiety.

• Again it is a form of mild ecstasy coming from the frontal lobe

of the brain in which the backward cortex sends signals to the

frontal cortex via a mild sedative

Relaxation techniques

• Although stress levels vary across society, the fact remains that

stress can be detrimental to one's health.

• In order to combat this stress, there have been a variety of

methods developed that have been proven to reduce stress and

its consequences in everyday life.

• The majority of techniques can be classified in to either

Physical, Mental or Therapeutic techniques.

1. Physical relaxation technique

• Breathing techniques are one of the easiest ways to reduce stress.

They require little effort and can be done anywhere at any time.

• Proper breathing techniques that incorporate deep abdominal

breathing have been shown to reduce the physical symptoms of

depression, anxiety and hypertension as well as everyday emotional

symptoms of anger and nervousness.

• Progressive muscle relaxation is a relaxation technique that requires

an individual to focus on flexing and holding a certain set of muscles

and then slowly relaxing those same muscles.

2. Mental technique

• Meditation has long been practiced in other regions around the

world. However, it is a practice that is fairly new to North

America and it is gaining attention quickly for the physical and

psychological benefits it provides to your body.

• Studies have shown that in addition to reducing physiological

and psychological stresses placed on your body, individuals who

practice meditation have much fewer doctor visits for both

physical and psychological illnesses.

3. Therapeutic relaxation

• Relaxation techniques used in therapy by a certified counsellor

or therapist could include any of the previous techniques

discussed.

• Professionals in the fields of psychology or counselling will have

the ability to administer a variety of these techniques.

• If they feel it is appropriate they may prescribe medication to

assist the patient with relaxation.

Mediation

• The relaxation response reduces the body„s metabolism, heart

and breathing rate, blood pressure, muscle tension, and calms

brain activity. It increases the immune response, helps

attention and decision making, and changes gene activities

that are the opposite of those associated stress. The relaxation

response is achieved through meditation. Benson's meditation

technique involves these four steps:

1. A quiet environment to help focus

2. A mental device to help keep attention constant (a sound or

word said repeatedly)

3. A positive attitude to avoid getting upset over failed attempts

4. A comfortable position

Autogenics

• The process of autogenics is by relaxing muscles deeply, and by

doing so, the mind follows through and relaxes as well. There as

six parts to autogenics training:

• 1. Heaviness in parts of the body (arms and legs feel heavy)

• 2. Warmth in parts of the body (arms and legs feel warm)

• 3. Heartbeat (heart is calm)

• 4. Breathing (breathing is calm)

• 5. Warmth in the abdominal area

• 6. Forehead is cool

Benefits of relaxation

• The benefits of relaxation can be found in three main areas of an individual„s health, including; mental, physical and physiological health.

mental

• Mental health is very important and needs to be worked on every day. Relaxation can help with much impairment that can occur in one's mental health.

Physical

• Physical health is also something that needs to be worked on daily, whether it is exercise, healthy eating, or relaxation, States that blood pressure, heart rate, and respiration rate will all decrease when one is relaxed.

Physiological

• In regards to the nervous system, relaxation can also play a big role.

• An individual will go from active and alert, which is the sympathetic, to parasympathetic which is rest and digest, when they are relaxing, it gives the body time to catch up.

8.4. Stretching techniques of soft tissue

Soft tissue stretching in sports massage

• Therapeutic muscle stretching can be described as a voluntary

lengthening of muscle and connective tissue with the overall goal

of increasing general flexibility and/or range of motion (ROM)

about the affected joint(s).

• Each type of sport has its own demands, and every athlete has their

own personal flexibility requirements as one of the components for

optimal athletic performance.

• Even though stretching is often viewed as the means to increase

mobility, flexibility can be achieved in a variety of ways where

muscle stretching is one common method.

Types of Stretching Technique Exercises

• There are a number of different types of stretching exercises

which can be done to improve flexibility. Here we explain

static stretching, dynamic stretching, PNF and ballistic

stretching.

• 1. static stretching- Static, or isometric stretching is a type of

stretching where the muscle is stretched until your feel a gentle

‗pull„, or stretch on the muscle. The stretch is then held for a

period of time, usually upwards of 10 seconds before relaxing

the muscle.

2. Dynamic stretching

• This type of stretching is very much in fashion these days,

particularly in sport for warming up.

• It involves stretching your muscles whilst moving, either by leg

swings, or by performing sports specific drills.

It works with„ sensors in the muscle called muscle spindles.

Muscle spindles are sensors within the muscle which sense the

speed a muscle is being stretched.

• A muscle can be statically flexible but then if suddenly asked to

move at speed then muscle spindles may kick in to prevent your

muscles lengthening.

3. PNF Stretching

• PNF stands for Proprioceptive Neuromuscular Facilitation and

can take on several forms including hold-relax; contract-relax; and

rhythmic initiation.

PNF started to become popular in the 1960s and has since become

a common treatment for many physiotherapists and other sports

injury professionals.

PNF can be either completely passive (meaning the therapist

moves the limb through its ranges of motion) or active assisted, in

which the athlete plays a role in the treatment.

In this case, it requires an isometric contraction before the stretch.

4. Ballistic type stretching exercises

• This type of stretching is where you stretch the muscle as far as it is

comfortable to do so. Then, at the end range of movement you bounce

or force the joint that little bit further.

• This is generally frowned on these days, because the act of forcing a

muscle beyond its comfortable range can damage it.

• However, Martial artists and Ballet dancers (extreme joint range of

movement is required) often include it in their stretching routines.

• It may also be used in rehabilitation to increase joint range of

movement. But be careful!

5. Neural Stretching

• Neural stretching refers to stretching the structures of the nervous

system. This is necessary for injuries where there is excess neural

tension, for example muscle related sciatic pain.

• Examples also are commonly found in the neck, shoulder, or

pelvis area.

• Neural stretches are adaptations of neural tension tests, such as

the slump test and the upper limb tension test.

• The limb is taken to the point of stretch and held for a maximum

of 10 seconds, although initially, this may be as little as 3-4

seconds to avoid causing damage to the nerves.

• Types of stretching like this should only be performed under the

supervision of a qualified therapist.

8.5. Balance and coordination exercise

Definition-

• Coordination is what happens when you use two or more body

parts at the same time to complete a task.

• Motor coordination can generally be broken down into three

separate skills:

Fine motor skills: the coordinated movement of small

muscles, like in the hands when writing or drawing.

Gross motor skills: the coordinated movement of large

muscles like the legs or arms, including walking, running, and

lifting weights.

Hand-eye skills: the ability of the eyes to coordinate visual

information and direct the hands to perform a task, like when you

use a computer mouse or catching a ball.

The benefits of coordination

• Often the unsung hero of physical exercise, the benefits of

coordination are many. The development of better coordination

helps with many aspects of physical wellbeing, but increasingly,

studies are showing that developing better coordination can help to

combat the risk of injury later in life and help improve mental

health, too.

• By incorporating some coordination exercises into your daily

routine, you can begin to improve multiple aspects of your

wellbeing.

• Not only can coordination training help you improve your

technique and form during exercise, but it could also positively

affect your mood and mental health.

• Balance is the ability to control your body in space while performing

static movements, and it„s an integral component of coordination.

• It's the cornerstone of performing the most basic of functions, from

walking up a flight of stairs to effectively completing high-intensity

workouts.

• Effective movement requires a stable core, which we can enhance

through specific exercises to improve balance. Additionally, balance

training plays a role in promoting general fitness and quality of life and

lessens the risk of injury, this is especially important as we grow older.

• Activity

1. List down the types of stretching and activities/exercises that

used to improve those stretches.

2. Write some easy exercises that may improve balance and

coordination

3. List the techniques of relaxation with their characteristics.

THE END

Jimma University, 2020